The Journal of arthroplasty
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The effect of procedure duration on joint arthroplasty survivorship in the USA is unknown. We examined the association between procedure duration with primary total hip arthroplasty and total knee arthroplasty survivorship at 8 years in the Medicare population using 1997 to 2004 Medicare claims data. Procedure duration was determined using anesthesia time as a proxy. ⋯ Total knee arthroplasty procedures shorter than 90 minutes, between 150 and 180 minutes, and more than 240 minutes had significantly higher revision rates than those lasting 120 to 150 minutes. Total hip arthroplasty procedures lasting more than 240 minutes also had a significantly higher revision risk than those lasting 120 to 150 minutes. Our findings support the general belief that longer procedures are associated with the greater probability of complications.
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Injury of the infrapatellar branch of the saphenous nerve (ISN) may be caused by a surgical laceration or trauma about the knee and can result in formation of a painful neuroma. There has been no report of knee stiffness after a total knee arthroplasty secondary to a painful neuroma of the ISN. ⋯ A neuroma of the ISN was resected, and the pain as well as the stiffness of the knee resolved. A source of pain such as a neuroma should be considered as a cause of reversible knee stiffness or "pseudoarthrofibrosis" after a total knee arthroplasty.
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Comparative Study
Decreased venous thromboembolism with injectable vs oral anticoagulation after discharge for major orthopedic surgery.
The use of outpatient anticoagulation after major orthopedic surgery with oral or injectable anticoagulants is recommended by national guidelines. A retrospective analysis of medical and pharmacy claims data using the PharMetrics Patient-Centric Database Inc, Watertown, Mass, was conducted. After adjusting for covariates, patients receiving warfarin were approximately 30% more likely to experience a venous thromboembolism than those receiving an injectable anticoagulant (6.3% vs 4.8%; adjusted odds ratio, 1.3; 95% confidence interval, 1.1-1.5) by 30 days. ⋯ No significant differences in the incidence of major bleeding events between the cohorts were observed (incidence of major bleed <0.4%). These findings support the randomized controlled studies and expand the data to the real-world perspective. Clinicians should evaluate these data alongside the clinical trial data when selecting the safest and most effective prophylactic therapy for postdischarge anticoagulation.
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We retrospectively reviewed 54 patients (92 hips) who underwent cementless total hip arthroplasty for bony ankylosis in ankylosing spondylitis between September 1988 and 2002. The mean age of the patients was 25.5 years. The mean duration of follow-up was 8.5 years. ⋯ Heterotopic ossification was seen in 12 patients; reankylosis rate was 0%. Thirteen (14%) arthroplasties were revised because of aseptic loosening. Kaplan-Meier survivorship analysis with revision as end point revealed 98.8% survival at 5 years and 85.8% survival at 8.5 years follow-up.
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Randomized Controlled Trial Multicenter Study Comparative Study
Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award.
The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. ⋯ Total hip arthroplasty patients also had superior WOMAC function scores (81.8 +/- 10.2 vs 65.1 +/- 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.